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Hound Dog Recovery P.O. Box 28 Smyrna DE 19977 Phone 302-836-3806 Fax 302-836-3805

CLIENT: _____________________

Repossession Order Name___________________________________________Acct#___________________ SSN__________________DOB______________ License Plate #__________________ Address________________________________________________________________ Other Address(Family Members)_______________________________________________________________ References_______________________________________________________________ Home Phone ____________________________Cell Phone________________________ Employer_________________________Address________________________________ Year of Vehicle___________Make_________________Model_____________________ Color___________________________ Key Code_______________________________ VIN#___________________________________________________________________ Amount of Payments Past Due $_______________Date of last payment______________ Blanket Hold Harmless Agreement This is your authorization to act as our agent to collect or repossess, on sight, all collateral which we assign to you which is covered by default contract. We agree to indemnify and hold you harmless from and against any and all claims except unauthorized or unlawful act of your firm. You will not be held Liable for the mechanical operation of the vehicle or for insurance protection except in case of your neglect. Authorized Signature _________________________________

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